Enomoto Con, Inui N, Kato T, et al

Enomoto Con, Inui N, Kato T, et al. tumor shrinkage was observed. However, 5?months later, the left chest pain had progressed, and enlargement of the primary tumor LEFTYB and left cervical and left axillary lymph nodes was noted (Physique?1b), along with new metastatic lesions in the brain. After informing the patient of the risk of exacerbation of interstitial pneumonia, the antiprogrammed cell death 1 (PD\1) antibody pembrolizumab was administered as a second\line treatment, and the tumors shrank significantly (Physique?1c). Ten months after starting pembrolizumab treatment, pembrolizumab was discontinued due to arthralgia of the hands related to the drug. He had no acute exacerbation of interstitial pneumonia and maintained tumor shrinkage for more than 2?years after treatment interruption. DISCUSSION Sarcomatoid carcinoma includes pleomorphic carcinoma, carcinosarcoma, and pulmonary blastoma. Pleomorphic carcinoma is usually a poorly differentiated non\small\cell carcinoma that contains at least 10% spindle and/or giant cells or a carcinoma consisting only of spindle and giant cells. 9 With regard to pulmonary pleomorphic carcinoma, surgery, chemotherapy, and radiation therapy have been performed, but many reports indicate that chemotherapy and radiation therapy are not effective. The promising effects of chemotherapy with bevacizumab have been reported for patients with pulmonary pleomorphic carcinoma, 10 so anti\angiogenic inhibitors may be useful for treating pleomorphic carcinoma. Because driver gene abnormalities are sometimes found in pleomorphic carcinoma and molecular\targeted drugs are effective in some cases, 11 , 12 , 13 , 14 a search for driver gene abnormalities, including mutations, is recommended. ICIs have revolutionized treatment in advanced lung cancer. 6 , 7 The PD\L1 expression in NSCLC is used to predict the therapeutic efficacy of ICIs as better therapeutic effects can be expected for tumors with a high expression of PD\L1. 15 Recent studies have reported that 70C90% of pulmonary pleomorphic carcinomas show a high expression of PD\L1. 16 , 17 Therefore, anti\PD\1/PD\L1 antibodies may be expected to be effective in patients with pulmonary pleomorphic cancer. Several other Temanogrel case reports have shown tumor shrinkage with pembrolizumab treatment. 18 , 19 , 20 In the present case, the PD\L1 TPS was 65% and the tumor clearly shrank after the initiation of pembrolizumab treatment. Several prospective and retrospective studies have recently been reported concerning the efficacy and safety of anti\PD\1/PD\L1 Temanogrel antibodies in NSCLC associated with interstitial pneumonia. Eighteen patients were enrolled in a Temanogrel phase II study to evaluate the efficacy and safety of nivolumab in NSCLC patients with interstitial pneumonia. 21 Fujimoto et al. 21 reported a response rate of 39%, median progression\free survival of 7.4?months, and median overall survival of 15.6?months. Acute exacerbations of interstitial pneumonia were found in two patients (11%) in this phase II study, but there were no treatment\related deaths. Another phase II study of atezolizumab for NSCLC with interstitial pneumonia was terminated early owing to 29.4% of the patients (five of 17) experiencing acute exacerbation of interstitial pneumonia. 22 In terms of acute exacerbation of preexisting interstitial pneumonia induced by cytotoxic chemotherapy, a honeycomb pattern on CT 5 and a Temanogrel low predicted FVC 23 have been reported to be the most common risk factors. A phase II study of nivolumab 21 excluded patients with a honeycomb pattern on HRCT or with a predicted VC 80%. In addition, the exclusion criteria included collagen vascular disease (CVD)\associated interstitial pneumonia, assessed by screening for CVD\associated antibody..